Provider Demographics
NPI:1124165774
Name:DEPARTMENT OF BEHAVIOUR HEALTH, SB COUNTY
Entity type:Organization
Organization Name:DEPARTMENT OF BEHAVIOUR HEALTH, SB COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MH CLINICIAN 3
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:LALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-421-9378
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-9378
Mailing Address - Fax:909-421-9494
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9378
Practice Address - Fax:909-421-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS7515283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital